Mortalidade intra-hospitalar de crianças submetidas a cirurgia cardíaca para correção de Cardiopatia Congênita em um centro de referência no estado do Amazonas

Abstract

Introduction: Congenital heart diseases are responsible for high infant morbidity and mortality at both global and national levels. In the Northern Region of Brazil, the scarcity of epidemiological studies on this condition in children hinders the analysis of clinical outcomes and the development of appropriate care strategies. Objectives: To analyze the trends in in-hospital mortality among children who underwent surgeries for the correction of congenital heart diseases between 2014 and 2022 at a referral hospital in the Northern Region. Methods: Analytical retrospective cohort study, approved by the UFAM Research Ethics Committee, conducted at the Fundação do Coração Hospital Francisca Mendes, involving patients aged 0 to <19 years who underwent cardiac surgery between 2014 and 2022. Clinical and sociodemographic data were collected via the REDCap platform. The primary variable was in-hospital mortality, and other variables included gestational, clinical, and surgical factors. Statistical analysis was performed using R software, with application of the chi-square test. Limitations inherent to retrospective studies are recognized, such as selection bias and incomplete data. Results: A total of 135 medical records of children undergoing cardiac surgery between 2014 and 2022 were analyzed. The peak in mortality occurred in 2017, with 22 deaths among 123 procedures. Most patients were male (51.8%), of mixed race (88%), and born in Manaus (65%). Only 3.7% underwent fetal echocardiography, and 56% had extracardiac malformations. The median age was 5 months, with a predominance of infants (71.8%) and a mean BMI of 13.7. The highest mortality was concentrated in category 3 of the RACHS-1 score (51%). The average cardiopulmonary bypass time was 150 minutes, with a high rate of blood transfusion (99%), use of peritoneal dialysis (35%), and prolonged parenteral nutrition (6%). The main causes of death were surgical complications, with the Blalock-Taussig shunt being the most associated procedure, accounting for 23 deaths. Observed mortality in RACHS-1 category 3 was 51.8%, significantly higher than the expected rate of 9.5%. Conclusion: An increase in in-hospital mortality was observed over the analyzed period, with a peak in 2017 (17.9%). The patient profile revealed a predominance of mixed-race individuals, born in Manaus, delivered at term, and with a balanced sex distribution. Prenatal coverage was limited, with a low rate of fetal echocardiography (3.7%) and no karyotyping, which hindered the identification of associated malformations. The most affected age group was infants, with higher mortality among newborns. The surgeries most associated with death were the Blalock-Taussig shunt, tetralogy of Fallot repair, and ventriculoseptoplasty. The main causes of death were cardiovascular (75.5%) and infectious (24.5%).